Review Article
Industrial Health 2009, 47, 469–478
Individual Susceptibility to Occupational Contact Dermatitis Sanja KEZIC1*, Maaike J. VISSER1 and Maarten M. VERBERK1 1Institute
of Occupational Health, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands Received May 5, 2009 and accepted August 25, 2009
Abstract: Occupational Contact Dermatitis (OCD) is one of the most common work-related diseases. High risk occupations are in health care, hairdressing, food sector and metal industry. OCD tends to become chronic; persistent OCD often results in impaired quality of life and loss of work ability. The purpose of this article is to review the present knowledge on the factors which determine individual susceptibility to acquire OCD. Recent discoveries regarding genes involved in the skin barrier, inflammatory response and biotransformation of xenobiotics provide more insight in the individual susceptibility for OCD. Knowledge of the factors which predispose to OCD is useful in occupational health practice for the application of preventive measures and for career guidance for apprentices and workers in high risk occupations. Key words: Susceptibility, Contact dermatitis, Occupational, Filaggrin, Cytokines, Genetic polymorphisms, Skin barrier, Atopy
Introduction Occupational contact dermatitis (OCD) is one of the most common work-related illnesses in many developed countries, accounting for up to one third of all occupational diseases1–5). Data on the prevalence of OCD vary from country to country, mainly due to lack of standardised case definitions, diagnostic methods and registration systems6, 7). A high prevalence has been documented in specific occupational groups, such as nurses, hairdressers, food processing workers and metal workers1–5). OCD, which mainly affects the hands, is an inflammatory skin condition caused by skin contact with an exogenous agent. It can broadly be divided into allergic (ACD) and irritant (ICD) contact dermatitis. The differentiation between ICD and ACD is difficult since the clinical and histological features of both diseases share common characteristics2). In the work place, ICD is the more prevalent form accounting for 50–80% of contact dermatitis (CD)2, 5, 8, 9) although in some sectors such as the construction industry, ACD prevails10). ICD is a cutaneous inflammation *To whom correspondence should be addressed. E-mail:
[email protected]
resulting from a direct cytotoxic effect of a chemical or physical agent without the production of specific antibodies. Depending on the exposure pattern and the irritation potential of a chemical, acute and chronic forms of ICD can occur in the workplace. Acute ICD develops after exposure of the skin to a strong irritant, mostly as a result of an accident at work2). Chronic ICD, associated with repetitive skin exposure to irritants, is a consequence of a stepwise progression of the skin barrier damage resulting in an eczematous skin reaction11). The most common skin irritants in the work place are wet work, soaps, organic solvents and mechanical hazards such as pressure and friction9). Allergic contact dermatitis (ACD) is a type IV, delayed or cell-mediated, immune reaction which occurs after sensitization to an allergenic compound12). ACD develops in two sequential phases: induction and elicitation. In the induction phase, topical exposure to a chemical allergen leads to sensitization of the individual. If the sensitized person is exposed subsequently to the inducing chemical allergen, at the same or different skin site, the cutaneous inflammatory reaction will follow that should be classified clinically as ACD. The sensitization and elicitation processes are mediated by T lymphocytes. The complex interaction of epidermal cytokines and chemokines medi-
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S KEZIC et al. Table 1.
Genetic susceptibility markers for ICD in recent cohort studies
Protein
Gen/allele
Effect size
Reference
TNF-α
(in low exposed group) TNFA-308 G/A TNFA-308 A/A
OR=3.1 (95% CI: 1.38–6.88)* OR=9.1 (95% CI: 2.2–38.0)*
19
IL-1α/IL-1β
IL-1A-889 (low exposed group) IL-1A-889 IL1B-31
Group difference, p=0.008* OR=1.02 (95% CI: 0.76–1.36) OR=0.89 (95% CI: 0.67–1.19)
19
IL-8
IL8-251
OR=0.88 (95% CI: 0.67–1.15)
19
IL-10
IL10-1082 IL10-592
OR=1.07 (95% CI: 0.81–1.41) OR=0.57 (95% CI: 0.23–1.40)
19
FLG
R501X, 2282del4
OR=1.9 (95% CI: 1.02–3.59)*
23
*p
